Chemotherapy and COVID-19 Outcomes in Patients With Cancer

Abstract

PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

Professional Assessment of the Impact of COVID-19 on Handling NET Patients

“…Indeed, retrospective series report a higher mortality rate of COVID-19 patients when on active cancer treatment receiving chemotherapy [13,20]. In contrast, other register data did not find an excess mortality for cancer patients on active treatment [21,22]. As systemic chemotherapy is only used in pancreatic NET patients, where several alternative treatments are available, it might be justified to delay initiation of systemic chemotherapy in NET patients.…”

Extending the range of symptoms in a Bayesian Network for the Predictive Diagnosis of COVID-19

“…It could be argued that if the patient had not recently undergone chemotherapy, his disease severity would have been mild, supporting the model outcome. However, research shows this hypothesis is a point of contention, with studies such as Jee et al, (2020) disputing chemotherapy as a risk for COVID-19 severity.…”

COVID‐19 and the risk to cancer patients in China

“…7,8 With regard to the impact of anti-cancer treatments on COVID-19 risk, the jury is perhaps still out, but, to the relief of oncologists around the world, there are increasing data to support the use of gold standard treatments. 8,9 Hopefully, further studies will confirm that specific anti-cancer therapies (surgery, chemotherapy,…”

“…5 diagnosis, disease stage, treatment, gender, age and co-morbidities. [7][8][9][10] Older age and co-morbidities, which are established risk factors for severe events and death from COVID-19, are more common in patients with cancer. However, there is growing evidence that even after correcting for such confounders, patients with haematological malignancies and active cancer (progressing vs remission) are at higher risk from the virus.…”